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A case of pemphigus vegetans presenting as chronic pustular dermatitis of the foot
( Sunyoung Jo ),( Hanhim Jeong ),( Seunggi Hong ),( Jaewan Go ),( Hyunjoo Lee ),( Eunphil Heo ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Pemphigus vegetans is a variant of pemphigus vulgaris mainly involving skin folds, face, scalp and mucous membranes. Of the two subtypes, Hallopeau type pemphigus vegetans starts with pustules with subsequent vegetation, and has a relatively benign course. In this case, the patient is an 87 year-old woman presenting with erythematous pustules on left sole suspicious of chronic pustular dermatitis. Three years ago, the patient had presented with macerated erythematous papules and plaques on external genitalia, inguinal area and left axilla which were improved after treatment with oral corticosteroid. She had been diagnosed as pemphigus vegetans by her laboratory findings of positive Desmoglein 1, Desmoglein 3 and pathologic findings of papillomatosis, acanthosis, suprabasal acantholysis and microabscess containing eosinophils. Under suspicion of infection with positive culture result of extended-spectrum beta-lactamase producing Escherichia coli from pustule, she was treated with IV antibiotics. Pustules recurred and vegetating lesion appeared after partial improvement, then she was treated with IV corticosteroid. After showing complete response and slow tapering of corticosteoid, there has been no recurrence with low dose oral steroid. We report a rare case of Hallopeau pemphigus vegetans misunderstanded as chronic pustular dermatitis because of atypical involvement of foot and positive bacterial culture in an 87-year-old female.
Go Eun Bae,Jaewan Jung,Soo-Youn Lee 대한임상검사정도관리협회 2023 Journal of Laboratory Medicine And Quality Assuran Vol.45 No.1
The measurement of metanephrine (MN) and normetanephrine (NMN) in plasma and urine using liquid chromatography-tandem mass spectrometry (LC-MS/MS) is the gold standard for the initial biochemical testing for pheochromocytomas and paragangliomas (PPGLs). Despite their high diagnostic value, there is a lack of consensus on the stability of MN and NMN in clinical specimens. This study aimed to analyze the stability of MN and NMN in both plasma and urine using LC-MS/MS under various conditions. Plasma and urine samples were prepared by spiking them with standard materials of MN and NMN. The samples were pretreated under solid phase extraction and analyzed using the LC-MS/MS system (Agilent Technologies, USA). In both plasma and urine specimens, MN and NMN were stable under the following conditions: (1) room temperature for 24 hours, (2) 4℃ for 8 days, (3) –20℃ for 8 days, and (4) –80℃ for 7 months. MN and NMN were stable after at least three cycles of the freeze and thaw process, and stable for 7 days in a container with dry ice. In this study, we comprehensively evaluated the stability of MN and NMN in plasma and urine and made recommendations to improve specimen handling to ensure reliable testing for PPGLs.
A case of Mycobacterium massiliense soft tissue infection
( Hanhim Jeong ),( Sunyoung Jo ),( Seunggi Hong ),( Jaewan Go ),( Eunphil Heo ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Mycobacterium massiliense is a new species in the Mycobacterium chelonae-Mycobacterium abscessus group, which was first isolated in 2004 from the sputum of a patient with hemoptoic pneumonia. It is an acid-fast bacillus that is classified as a pathogenic ‘rapid growing’ nontuberculous mycobacteria. A 64-year-old female patient presented with a tender, erythematous to brownish subcutaneous nodule located on her left posterolateral thigh for 2 weeks. She had no history of medical procedure or trauma and the symptom was refractory to antibiotic medication. Skin biopsy and bacterial, fungus and AFB culture were done in the lesion. Bacterial and fungus culture of the pus specimen revealed negative results. AFB culture stain was positive, and Mycobacterium massiliense was identified. It showed resistance to ciprofloxacin, doxycycline, and trimethoprime/sulfamethoxazole. Histopathologically, it revealed epidermal hyperplasia and a neutrophilic abscess with granulomatous inflammation. AFB and PAS staining results were negative. The patient was treated with a combination of amikacin, cefoxitin and clarithromycin for first 4 weeks followed by oral clarithromycin monotherapy for several months. The skin lesion showed improvement after the treatment.